While some advocates are lauding the Governor’s “full” funding of the AIDS Drugs Assistance Program, we at the Center for Health Justice feel compelled to point out that not only does cutting off county jails – which have received support from ADAP for HIV medications for years – mean that ADAP is no longer fully funded, but that this cut places the financial burden of HIV medications back on county governments which are less able to bear the burden of these costs, and will likely result in inconsistent medical treatment of HIV in county jails resulting in higher ADAP and medical costs to the community when county jail inmates return.

For over the past decade, California’s ADAP has covered the cost of HIV medications for county jail inmates, based on the fact that many jail inmates are likely ADAP clients, i.e. without health insurance or sufficient income to pay for the expensive medications themselves, and that an interruption of medication during relatively short jail stays would result in higher long-term medical costs to ADAP and the public health system than the cost of continuing to pay for the medication during incarceration.

We know what happens when county jails are cut off ADAP: it happened in the late 1990s in Los Angeles County and resulted in people living with HIV being told it would be weeks before their HIV medications, commonly available in the community, could be provided. People missed doses and risked developing HIV disease resistant to treatment, because HIV is effectively treated only when medication is taken with 95% consistency. Thus, a short jail stay has dramatic health implications if HIV medications are not readily available.

Cutting ADAP to the Los Angeles County Sheriff’s Department would result in an increase of at least three million dollars in their pharmaceutical costs per year; in San Francisco, a million dollars. These entities, and counties generally, are in a worse position than the State to absorb the additional costs of ADAP medications: counties have their own deficits resulting from a decrease in property and sales tax income before the State passes on the effect of its budget deficit.

At the very least, county jails will cut their provision of “release meds” – a multi-day supply of medications provided to people leaving jail anticipating the inevitable delay in reestablishing medical services in the community – since they are not legally required to provide medical care after incarceration. This will undoubtedly result in missed doses for among this already vulnerable group of people.

We urge the Governor and the legislature to reconsider this budget expense based on its longer term cost savings to ADAP and the public health system of California.